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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597736
Report Date: 10/18/2022
Date Signed: 10/18/2022 03:53:34 PM


Document Has Been Signed on 10/18/2022 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CARVER HEAD START/STATE PRESCHOOLFACILITY NUMBER:
191597736
ADMINISTRATOR:ROSELIA GOMEZFACILITY TYPE:
850
ADDRESS:19200 ELY STREETTELEPHONE:
(562) 229-7933
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:38CENSUS: 23DATE:
10/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Cynthia SantosTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) T. Tran arrived at Carver Head Start to conduct a Case Management inspection that was self-reported on 10/12/2022 regarding to care and supervision concerns. Upon arrival, LPA met with Cynthia Santos, Director and we toured the facility indoor and outdoor. LPA observed proper care and supervision.

File review was completed. LPA obtained personnel report, and child’s document. LPA conducted interviews with staff, children, and other. On the day of the incident, there 6 children enrolled. LPA observed the children's restroom within the classroom premises. None of the children were impacted by this incident. All children were observed to be healthy. Based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Cynthia Santos.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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